Provider Demographics
NPI:1427191311
Name:SPEICHER, JANICE MARIE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 981145
Mailing Address - Street 2:1777 SUN PEAK DRIVE, SUITE 140-H
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-1145
Mailing Address - Country:US
Mailing Address - Phone:435-640-3966
Mailing Address - Fax:
Practice Address - Street 1:1777 SUN PEAK DR
Practice Address - Street 2:SUITE 140-H
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6725
Practice Address - Country:US
Practice Address - Phone:435-640-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120742-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional